Provider Demographics
NPI:1689345696
Name:YAHID, JASMINE SHAHRENAZ (LPCC, R-DMT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:SHAHRENAZ
Last Name:YAHID
Suffix:
Gender:F
Credentials:LPCC, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11628 MONTANA AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4609
Mailing Address - Country:US
Mailing Address - Phone:310-405-2487
Mailing Address - Fax:
Practice Address - Street 1:17195 NEWHOPE ST STE 205
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4211
Practice Address - Country:US
Practice Address - Phone:310-405-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7543101YM0800X
MA2478225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist